Risk scores are statistical indicators based on prescribing patterns compared to specialty peers. They are NOT allegations of fraud, misconduct, or improper care. Many legitimate medical reasons can explain outlier prescribing.
Read our methodology →🤖 ML Fraud Detection Score: 98%
Machine learning model identifies prescribing patterns consistent with confirmed fraud cases. This is a statistical indicator, not an accusation.
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
252
Total Claims
$15K
Drug Cost
86
Beneficiaries
$174
Cost/Patient
Risk Score Breakdown 11/100
Score components are additive. Read full methodology
Peer Comparison vs. 3,327 Radiation Oncology providers
+56%
Opioid rate vs peers
14.7% vs 9.4% avg
-22%
Cost per patient vs peers
$174 vs $224 avg
+134%
Brand preference vs peers
13.9% vs 5.9% avg
⚠️ Opioid + Benzodiazepine Co-Prescriber
This provider prescribes both opioids and benzodiazepines. The FDA has issued a Black Box Warning about the life-threatening risks of concurrent use.
🔎 Data Overview
Our machine learning model — trained on 281 confirmed fraud cases — gives this provider a "Very High" fraud-pattern score. All 20 decision trees in our ensemble model agree that this provider's prescribing patterns resemble those of confirmed fraud cases. This is a statistical finding, not an accusation.
This provider co-prescribes opioids and benzodiazepines — a combination carrying an FDA Black Box Warning due to increased risk of respiratory depression and death. While sometimes clinically necessary, this combination requires careful justification.
Prescribes only 6 unique drugs, which is unusually low. Most providers prescribe 30+ different medications. Narrow prescribing patterns deserve context about the provider's practice scope.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
14.7%
Opioid Rate
37
Opioid Claims
$521
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 35 claims · $7,651
Generic: 217 claims · $7,276
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Sucralfate | 16 | $2,251 |
| Lidocaine Hcl | 24 | $853 |
| Silver Sulfadiazine | 12 | $441 |
| Hydrocodone/Acetaminophen | 17 | $261 |
| Gabapentin | 15 | $175 |
| Lorazepam | 19 | $44 |
Prescribing Profile
6
Unique Drugs
11.0
Anomaly Score
Patient Profile
73
Avg Age
49%
Female
2.21
Avg Risk Score
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Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About